Provider Demographics
NPI:1154903623
Name:PROFESSIONAL HOME CARE LLC
Entity type:Organization
Organization Name:PROFESSIONAL HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:TOIQUINA
Authorized Official - Middle Name:
Authorized Official - Last Name:MCKOY
Authorized Official - Suffix:
Authorized Official - Credentials:CMA,CNA
Authorized Official - Phone:336-541-8046
Mailing Address - Street 1:2216 W MEADOWVIEW RD STE 114
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27407-3401
Mailing Address - Country:US
Mailing Address - Phone:336-541-8046
Mailing Address - Fax:
Practice Address - Street 1:301 S GREENE ST STE 8F
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27401-2660
Practice Address - Country:US
Practice Address - Phone:910-920-7726
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-24
Last Update Date:2023-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care